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o?t ia-m5 <br /> ORANGE COUNTY-CONTRACT CONTROL SHEET <br /> Routing Order: (1)Department,(2) IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk <br /> This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager <br /> determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for <br /> BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should <br /> be completed through the legal review process prior to being routed for signature. <br /> Department <br /> Party/Vendor Name: Personalized patient Home Assistance Party/Vendor Contact Person: Dorthea Farrington Contact Phone: 919-929- <br /> 4943 Party/Vendor Address: 109 Concord Drive City Chapel Hill State:NC Zip:27278 Department:DSS Amount: not to exceed <br /> $415,647 Purpose: in-home services Budget Code(s): 10400220-630000 Vendor# (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑Noll Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date 07/01/12 Approved by <br /> Board Yes No❑ Agenda Date:06/05/12 Title of Contract: In-Home Aide Provider Services Agreement <br /> If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No❑. If submitted for bid were <br /> bids/RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Date: `)S -12-- <br /> t <br /> IT Director <br /> (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the Information <br /> Technology Director as to technical content and information technology specifications: <br /> IT Director's Signature: Date: <br /> � Risk Man Bement <br /> Ef Include the following coverages: [�CGL; E Auto; [ 'WC; []Professional; R'Property; OR No Insurance Required ❑. Hold <br /> Contract pending receipt of Certificate of Insurance Er With incorporation of Insurance provisions as shown, this contract is approved <br /> by the Risk Manager: �Risk Manager's Signature: �/�� �� J• Date: (11' <br /> Financial Services <br /> This Contract is condition upon appropriation by the Board of Commissioners YesENo A budget amendment is necessary <br /> before approval Yes❑ No11]. If budget amendment is necessary, please attach to this form. his instrument has been pre-audited in the <br /> manner required by the Local Government Budget and Fiscal Control Act: <br /> Financial Services Director's Signature: �W`mow A Ast---, Date: 11 411 12" <br /> County Attorney <br /> Approval by Board [Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval b Manager❑ (Most other contracts$1,000 and above). Department Director approval only ❑(Under <br /> $1,000). This contract has bee I I i wed • roved by the Attorney as to legal form and sufficie cy: <br /> al) <br /> � <br /> Attorney's Signature -r Date: i <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes'No❑. <br /> This contract has been reviewed and is fs '::i tur- by e / esf�l�Iq r" <br /> Manager's Signature: - -/_/_ , rr Date: <br /> `; ®tom e lard A roved b BOCC on the da of 20 ..b -d for Chair signature IVA <br /> t..• day o ,20 . <br /> PP by day , �r <br /> Clerk's Signature: (to / /, Date: / <br /> Revised March 2012 <br />